Cardiovascular complications following renal transplantation
| Autor: | R. A. Sells |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Transplantation
medicine.medical_specialty Statin medicine.diagnostic_test medicine.drug_class business.industry Vascular disease Mortality rate Psychological intervention medicine.disease Internal medicine Angiography Epidemiology medicine Cardiology Medical prescription Intensive care medicine business |
| Zdroj: | Transplantation Reviews. 11:111-126 |
| ISSN: | 0955-470X |
| Popis: | Summary CAD is an important risk after renal transplantation and increases the death rate to a level many times higher than in individuals who do not suffer renal failure. Two prophylactic interventions are of proven value in the general patient population and for which there is indirect evidence of some survival benefit in pre- and posttransplant patients. They are: 1. Coronary revascularisation in appropriate patients identified by angiography; 2. “Statin” treatment in those experiencing posttransplant hypercholesterolaemia. The former is known to provide improved patient survival in diabetics, and by implication also non-diabetic renal transplant recipients. The latter is associated with a reduction of blood cholesterol levels towards normal, and with an improvement in the “atherogenic” fraction to levels which are associated with fewer myocardial infarctions and cardiac deaths in other large epidemiological studies. We may conclude that applying at least these two prophylactic steps would reduce the presently high death rate in the mid and long term after renal transplantation. Pre-transplant cardiac scintigraphy, with pharmacological stress, predicts reasonably accurately those individuals in whom coronary arteriography is indicated. Suitable patients may then have their coronary stenoses dealt with surgically to good effect. Normocholesterolaemia induced in selected patients by “statin” prescription seems logical, on hypothetical grounds, although there is need for a multi-centre trial involving 10 year follow-up to elucidate this effect. Recently licensed new immunosuppressives (FK506, MMF) seem to have little elevating effect on blood cholesterol levels, though more long-term data are needed. In the meantime, altering cyclosporine and steroid dosage with newer agents in susceptible recipients (hypercholesterolaemics, cardiopaths) or substitutive therapy, would seem a wise management strategy, the new drugs give future hope for even better control of cholesterol metabolism, and thus vascular disease. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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